2026-02-05_COI__GL__AL__WC__SAM__an_UL.pdf

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN

ACCORDANCE WITH THE POLICY PROVISIONS.

INSURER(S) AFFORDING COVERAGE

INSURER F :

INSURER E :

INSURER D :

INSURER C :

INSURER B :

INSURER A :

NAIC #

NAME:

CONTACT

(A/C, No):

FAX

E-MAIL

ADDRESS:

PRODUCER

(A/C, No, Ext):

PHONE

INSURED

REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED

REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

OTHER:

(Per accident)

(Ea accident)

N / A

SUBR

WVD

ADDL

INSD

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

$PROPERTY DAMAGE

BODILY INJURY (Per accident)

BODILY INJURY (Per person)

COMBINED SINGLE LIMIT

AUTOS

AUTOSAUTOS

NON-OWNED

HIRED AUTOS

SCHEDULEDALL OWNED

ANY AUTO

AUTOMOBILE LIABILITY

Y / N

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

OFFICER/MEMBER EXCLUDED?

(Mandatory in NH)

DESCRIPTION OF OPERATIONS below If yes, describe under

ANY PROPRIETOR/PARTNER/EXECUTIVE

E.L. DISEASE - POLICY LIMIT

E.L. DISEASE - EA EMPLOYEE

E.L. EACH ACCIDENT

ER

OTH-

STATUTE

PER

LIMITS(MM/DD/YYYY)

POLICY EXP

(MM/DD/YYYY)

POLICY EFF

POLICY NUMBERTYPE OF INSURANCELTR

INSR

DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

EXCESS LIAB

UMBRELLA LIAB $EACH OCCURRENCE

$AGGREGATE

OCCUR

CLAIMS-MADE

DED RETENTION $

$PRODUCTS - COMP/OP AGG

$GENERAL AGGREGATE

$PERSONAL & ADV INJURY

$MED EXP (Any one person)

$EACH OCCURRENCE

DAMAGE TO RENTED

$PREMISES (Ea occurrence)

COMMERCIAL GENERAL LIABILITY

CLAIMS-MADE OCCUR

GEN'L AGGREGATE LIMIT APPLIES PER:

POLICY

PRO-

JECT LOC

CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)

CANCELLATION

AUTHORIZED REPRESENTATIVE

ACORD 25 (2014/01)

© 1988-2014 ACORD CORPORATION. All rights reserved.

CERTIFICATE HOLDER

The ACORD name and logo are registered marks of ACORD

04/11/2025

Lightwell Insurance Advisors of Arizona, LLC

7165 E University Drive #129

Mesa AZ 85207-6410

Kevin Norton

480-834-8139 480-844-2166 service.az@lightwell.com

Arizona Ecumenical Council

DBA: Arizona Faith Network

PO Box 60953

Phoenix AZ 85082

Brotherhood Mutual Insurance Company 13528

A

Y Y 02MEA0311367 04/22/2025 04/22/2026

1,000,000

1,000,000

5,000

1,000,000

10,000,000

10,000,000

A

02MEA0311367 04/22/2025 04/22/2026

1,000,000

A ✖

02MEA0311367 04/22/2025 04/22/2026

1,000,000

1,000,000

A N Y 02WEA0375332 02/05/2025 02/05/2026

1,000,000

1,000,000

1,000,000

SEE ATTACHED ADDITIONAL REMARKS SCHEDULE, ACCORD 101, INCORPORATED HEREIN BY REFERENCE.

(This certificate replaces the certificate dated 02/26/2025 to include Nonowned Vehicle Liability coverage.)

Arizona Department of Health Services

150 N 18th Ave Ste 530

Phoenix AZ 85007

A COVERAGE (BGL61 4.7) AGGREGATE LIMIT: $500,000

COVERAGE LIMIT: $500,00004/22/202604/22/202502MEA0311367SEXUAL ACTS LIABILITYA

EFFECTIVE DATE:

NAMED INSURED

POLICY NUMBER

NAIC CODECARRIER

AGENCY

LOC #:

AGENCY CUSTOMER ID:

ofPageADDITIONAL REMARKS SCHEDULE

ADDITIONAL REMARKS

FORM TITLE:FORM NUMBER:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,

© 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

ACORD 101 (2008/01)

2 2

Lightwell Insurance Advisors

02MEA0311367

Brotherhood Mutual Insurance Company 13528

Arizona Ecumenical Council DBA: Arizona Faith Network

PO Box 60953

Phoenix, AZ, 85082

04/22/2025

25 CERTIFICATE OF LIABILITY INSURANCE

STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND EMPLOYEES, ARE NAMED AS ADDITIONAL INSURED ON POLICY NUMBER 02MEA0311367 AS FACILITY OWNER AND SPONSORING ORGANIZATION OF THE 2025 COOLING CENTERS, REGARDING ARIZONA FAITH NETWORK'S OPERATION OF TWO STATE COOLING CENTERS IN THE GOVERNMENTAL MALL, LOCATED AT 1818 W ADAMS ST, PHOENIX, AZ 85007 AND 1601 W JEFFERSON ST, PHOENIX, AZ 85007, UNDER THE STATE OF ARIZONA CONTRACT NO. CTR075257, EFFECTIVE MAY 1, 2025 THROUGH OCTOBER 15, 2025. THIS INSURANCE IS PRIMARY AND NON- CONTRIBUTORY, PURSUANT TO THE ATTACHED DESIGNATED ADDITIONAL INSURED ENDORSEMENT BGL-150 (4.5). WAIVER OF SUBROGATION APPLIES IN FAVOR OF STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES, BOARDS, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND EMPLOYEES, AS INDICATED ABOVE. SEXUAL ABUSE AND MOLESTATION COVERAGE IS INCLUDED. COVERAGE FOR THE

ADDITIONAL INSURED IS STRICTLY SUBJECT TO ALL TERMS OF THE POLICY.

(This certificate replaces the certificate dated 02/26/2025 to include Nonowned Vehicle Liability coverage.)